August 2026 Monthly AFCNA Webinar-ABNEnglish_508_v2029

ABNEnglish_508_v2029 - 1

Pdf Summary

This document is the <strong>Advance Beneficiary Notice of Non-coverage (ABN)</strong>, a Medicare form used when a provider believes Medicare may not pay for a particular item, test, service, or care. It informs the patient that if Medicare denies payment, the patient may be responsible for the cost.

Key points:
- The form identifies the patient, notifier (provider), and the specific item/service, along with the reason Medicare may not pay and the estimated cost.
- The patient is told to read the notice, ask questions, and choose one of three options:
  1. <strong>Get the service and bill Medicare</strong> for an official payment decision; if Medicare denies it, the patient may appeal.
  2. <strong>Get the service but do not bill Medicare</strong>; the patient pays, but cannot appeal because Medicare was not billed.
  3. <strong>Do not get the service</strong>; the patient is not responsible for payment and cannot appeal.
- Signing the form confirms the patient received and understands the notice.
- The form states it is <strong>not an official Medicare decision</strong>; for questions, contact <strong>1-800-MEDICARE</strong> (TTY users: <strong>1-877-486-2048</strong>).
- It also notes the right to request accessible formats and file a discrimination complaint.

The bottom section explains the form’s legal basis under the <strong>Paperwork Reduction Act</strong> and Medicare regulations.

Keywords

Advance Beneficiary Notice

ABN

Medicare form

non-coverage

patient responsibility

service denial

appeal rights

provider notice

estimated cost

Paperwork Reduction Act